Out of Our Comfort Zone: Pain Relief in Emergencies

800px-London_Air_Ambulance_G-EHMS
London’s Air Ambulance

Pain Relief in Emergencies

 

Morphine

Morphine

Morphine was first isolated in 1804 by Friedrich Serturner in Germany and distributed in 1817. It was more widely used after 1857 and the invention of the hypodermic needle.  It was originally named morphium by Serturner after Morpheus, the Greek god of dreams and used as a substitute for those addicted to opium or alcohol, until doctors realised that it was more addictive than either of these substances. Preloaded syringes have been used to give pain relief in emergencies and can be used in hospitals to relieve the pain of a heart attack.

 

Methoxyflurane

Methoxyflurane (Penthrane)

First used in surgical anaesthesia in 1960, it can also be used as an analgesic. Ambulance teams in Australia use this drug as a self-administered analgesic with those with traumatic injuries. It is no longer used as an anaesthetic as prolonged inhalation of high concentrations produce renal problems. This is an example of methoxyflurane as a self-administered analgesic. It is single-use and disposable and used to inhale penthrane. Blocking the opening near the mouthpiece increases the intensity and deepens the analgesia.

 

Cardiff Inhaler

Cardiff Inhaler

This inhaler is a modified Tecota Mark VI trilene inhaler. It was introduce into clinical use in 1959 and this example dates from 1959-1979. It could be used in intensive care and obstetrics.

 

Ketalar

Ketamine (Ketalar)

Ketamine can be used as both an anaesthetic and an analgesic and was developed by Parke-Davis in 1962. It was given to American soldiers in the Vietnam War and was also used in both the Falklands War and the first Gulf War. It is particularly useful as an emergency anaesthetic as it does not supress the patient’s airway to the degree of some other agents, and so patients may be able to breathe by themselves without additional airway or ventilation equipment. However, it has been noted that it can cause hallucinations when used as an analgesic or sedative.

 

Trilene

Trichloroethylene (Trilene)

Trilene’s anaesthetic properties were first described in 1911 and it was used as an anaesthetic from 1935 until the 1980s, particularly in obstetrics. It was first made in 1864 by German scientist Emil Fischer. Since then, it has had a number of other uses including cleaning and degreasing rocket engines, decaffeinating coffee and dry cleaning. It was found to be a carcinogenic.

 

Xylocaine

Xylocaine

Xylocaine is also known as Lidocaine and is a local anaesthetic which can be injected or applied as a gel to the skin. It was first created by Nils Lofgren in 1943 and was marketed from 1949.

 

Nubain

Nalbuphine (Nubain)

This can be used as an analgesic for moderate to severe pain, and can be used for postoperative pain, obstetrics and to supplement other drugs in producing general anaesthesia. This example was sold after 1978: it is no longer used in Britain and has been removed from the British National Formulary.

 

Oxygen Facepiece

This disposable mask delivered oxygen from a tank to a patient. It was manufactured after 1980.

 

Pulse Oximeter

The oximeter was invented in the 1940s and the pulse oximeter manufactured from 1979. The monitor uses red and infrared light to measure the amount of oxygen in a patient’s blood: red light is absorbed by oxygenated blood and infrared by deoxygenated, and this is measured by the monitor on the patient’s fingertip. This example was manufactured by the charity, Lifebox, which works to provide equipment for operating rooms worldwide.

 

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Entonox

Entonox is a 50/50 mixture of nitrous oxide and oxygen and is used as an analgesic. As it is known to be reasonably safe, it is used in emergencies, in dentistry and as a self-administered analgesic in obstetrics. This examples dates from 1963 and is designed to be portable.

 

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